急诊脑卒中识别评分量表在社区院前急救中筛选价值的探讨

The Value of the Use of the ROSIER scale in Community Pre-hospital Emergency Care

目的探讨急诊脑卒中识别(the recognition of stroke in the emergency room,ROSIER)评分量表在社区院前急救中对可疑脑卒中患者的快速筛选价值。方法以面、臂、言语、时间(the face arm speech time,FAST)评分量表为对照,急诊医师在社区院前急救中使用ROSIER评分量表对可疑脑卒中患者进行筛查,以综合临床诊断为金标准(根据患者的颅脑CT或MRI扫描,由神经专科医师拟定综合临床诊断标准),比较ROSIER评分量表和FAST评分量表敏感度、特异度、阳性预测值、阴性预测值和关联系数。结果 108例可疑脑卒中患者社区院前急救中,以综合临床诊断为标准,FAST评分量表的敏感度为88.6%[95%CI(82.6%,94.6%)],特异度为71.1%[95%CI(62.6%,79.6%)],阳性预测值为84.9%[95%CI(78.2%,91.7%)],阴性预测值为77.1%[95%CI(69.2%,85.0%)],关联系数为0.520;ROSIER评分量表的敏感度为90.0%[95%CI(84.3%,95.7%)],特异度为84.2%[95%CI(77.3%,91.1%)],阳性预测值为91.3%[95%CI(86.0%,96.6%)],阴性预测值为82.1%[95%CI(74.9%,89.3%)],关联系数为0.594。ROSIER评分量表对可疑脑卒中患者的筛选与综合临床诊断相关联(P<0.05)。ROSIER评分量表与FAST评分量表对可疑脑卒中患者筛选的阳性率比较,差异无统计学意义(P>0.05)。结论在社区院前急救中,使用ROSIER评分量表对可疑脑卒中患者进行筛选具有一定临床价值。

Objective To explore the value of the use of the Recognition of Stroke in the Emergency Room（ROSIER） scale in community pre-hospital emergency care.Methods Compared the Face Arm Speech Time（FAST） scale,emergency physicians prospectively used the ROSIER scale on suspected stroke patients in community pre-hospital stroke assessment.And the final diagnosis made by the consultant stroke physicians,after assessment and review of clinical symptomatology and brain imaging findings,was used as the reference standard for diagnosis in the study.Calculated the ROSIER scale and FAST scale like sensitivity（Se）,specificity（Sp）,positive predictive value（PPV）,negative predictive value（NPV）,and association coefficient（r）.Results In this study,108 suspected stroke patients were assessed in community pre-hospital emergency care.According to the final diagnosis,the FAST scale showed a diagnostic Se 88.6% [95%CI（82.6%,94.6%）],Sp 71.1%[95%CI（62.6%,79.6%）],PPV 84.9%[95%CI（78.2%,91.7%）],and NPV 77.1%[95%CI（69.2%,85.0%）].And the ROSIER scale showed a diagnostic Se 90.0% [95%CI（84.3%,95.7%）],Sp 84.2%[95%CI（77.3%,91.1%）],PPV 91.3%[95%CI（86.0%,96.6%）],and NPV 82.1% [95%CI（74.9%,89.3%）];The r value of the FAST scale and the ROSIER scale were 0.520 and 0.594 in this study.And the ROSIER scale was associated with the final diagnosis（P0.05）.However,there was no significant difference of positive rate between the ROSIER scale and FAST scale in recognition of stroke（P 0.05）.Conclusion The ROSIER scale was a useful stroke recognition tool in pre-hospital stroke assessment in Chinese mainland community.